Depression Tx Update: Managing Side Effects, Improving Efficacy

Aripiprazole, brexpiprazole, olanzapine, quetiapine, and risperidole are part of the treatment armamentarium for MDD

The following article is part of live conference coverage from the 2017 Psych Congress in New Orleans, Louisiana. Visit MPR's conference section for continuous coverage live from Psych Congress 2017.

NEW ORLEANS — In a presentation at the 2017 US Psych Congress, held September 16-19, Michael E. Thase, MD, professor of psychiatry at the Perelman School of Medicine of the University of Pennsylvania, discussed updates to antidepressant management, as well as challenges faced by clinicians managing major depression in patients.

Dr. Thase explored pharmacologic treatments of depression, including first-line antidepressants that are not mentioned in the most recent American Psychiatric Association (APA) guidelines from 2010. Among more recently introduced antidepressants, vilazodone 40mg/d was found to be very potent and well-tolerated. Vortioxetine had “enhancing effects on complex cognition, not necessarily memory or concentration but perhaps multi-step sequencing,” Dr. Thase said.

On the subject of adjunctive therapy, Dr. Thase recommended second-generation antidepressants (SGAs) in patients who are seriously ill or incapacitated. “If you are using adjunctive strategies early on, pick a treatment that compliments the first medication and matches the patient,” he explained. An additional point Dr. Thase made is that while combining antidepressants was once considered indicative of bad practice, it is now commonplace in the management of treatment-resistant depression.

Aripiprazole, brexpiprazole, olanzapine, quetiapine, and risperidole appear effective as adjunctive antidepressants, while olanzapine, quetiapine, and lurasidone are effective as monotherapy for bipolar depression. Additionally, quetiapine has established efficacy as monotherapy for major depressive disorder.

Side effects of antidepressants present significant challenges to adherence. Clinicians can manage sexual side effects by taking a history to understand dysfunction prior to treatment, treatment reduction, post-coital dosing, and antidepressant switching.

Weight gain may be more difficult to manage. While caloric intake can be reduced and exercise encouraged, Dr Thase advises that “preventing weight gain is easier than facilitating weight loss.”